Primary non-Hodgkin’s lymphoma of the common bile duct presenting as obstructive jaundice: a case report

Abstract

Introduction. Primary non-Hodgkin’s lymphoma of the extrahepatic bile duct presenting as obstructive jaundice is an extremely rare disease. Case presentation. We report a case of obstructive jaundice caused by primary non-Hodgkin’s lymphoma of the common bile duct (CBD), in a 67-year-old male patient. Our patient showed clinical evidence of obstructive jaundice, and tomography revealed a dilated common bile duct with the suspicion of intra ductal lithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, with efficient drainage and clinical resolution of the obstructive jaundice. One month later, the patient presented the same clinical signs of obstructive jaundice, only this time the ERCP revealed common bile duct distal stenosis. The next step was to perform an echoendoscopy (EUS), that visualized a homogeneous mass at the common bile duct distal level and cholangiocarcinoma was suspected. Fine needle aspiration (FNA) of the lesion obtained tissue fragments for histological examination. The diagnosis was diffuse B-cell type non-Hodgkin’s lymphoma in the marginal area, and the patient was evaluated in the Oncology Department for chemotherapy. Conclusions. It is very important to differentiate primary non-Hodgkin’s lymphoma of the bile ducts from other causes of obstructive jaundice, as the treatment approach and prognosis are fundamentally different. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the definitive diagnosis technique, avoiding surgical interventions and the classic exploratory laparotomy.

Keywords

• obstructive jaundice
• non-Hodgkin’s lymphoma
• echoendoscopy.